Editorial
Copyright ©2012 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Orthop. Sep 18, 2012; 3(9): 137-141
Published online Sep 18, 2012. doi: 10.5312/wjo.v3.i9.137
Strategy for prevention of hip fractures in patients with Parkinson’s disease
Jun Iwamoto, Yoshihiro Sato, Tsuyoshi Takeda, Hideo Matsumoto
Jun Iwamoto, Tsuyoshi Takeda, Hideo Matsumoto, Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo 160-8582, Japan
Yoshihiro Sato, Department of Neurology, Mitate Hospital, Fukuoka 826-0041, Japan
Author contributions: Iwamoto J and Sato Y contributed to the conception and design, acquisition, analysis and interpretation of data, and drafting the article; Takeda T and Matsumoto H revised the article critically for important intellectual content; Matsumoto H gave final approval of the version to be published.
Correspondence to: Jun Iwamoto, MD, PhD, Institute for Integrated Sports Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. jiwamoto@a8.keio.jp
Telephone: +81-3-33531211 Fax: +81-3-33529467
Received: April 13, 2012
Revised: September 10, 2012
Accepted: September 15, 2012
Published online: September 18, 2012
Abstract

Hypovitaminosis D and K due to malnutrition or sunlight deprivation, increased bone resorption due to immobilization, low bone mineral density (BMD) and an increased risk of falls may contribute to an increased risk of hip fractures in patients with Parkinson’s disease. The purpose of the present study was to clarify the efficacy of interventions intended to prevent hip fractures in elderly patients with Parkinson’s disease. PubMed was used to search the literature for randomized controlled trials (RCTs) regarding Parkinson’s disease and hip fractures. The inclusion criteria were 50 or more subjects per group and a study period of 1 year or longer. Five RCTs were identified and the relative risk and 95% confidence interval were calculated for individual RCTs. Sunlight exposure increased serum hydroxyvitamin D [25(OH)D] concentration, improved motor function, decreased bone resorption and increased BMD. Alendronate or risedronate with vitamin D supplementation increased serum 25(OH)D concentration, strongly decreased bone resorption and increased BMD. Menatetrenone (vitamin K2) decreased serum undercarboxylated osteocalcin concentration, decreased bone resorption and increased BMD. Sunlight exposure (men and women), menatetrenone (women), alendronate and risedronate with vitamin D supplementation (women) significantly reduced the incidence of hip fractures. The respective RRs (95% confidence intervals) according to the intention-to-treat analysis were 0.27 (0.08, 0.96), 0.13 (0.02, 0.97), 0.29 (0.10, 0.85) and 0.20 (0.06, 0.68). Interventions, including sunlight exposure, menatetrenone and oral bisphosphonates with vitamin D supplementation, have a protective effect against hip fractures elderly patients with Parkinson’s disease.

Keywords: Vitamin D, Vitamin K, Hip fractures, Parkinson’s disease, Mortality